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Oh, That Aching Migraine:
Migraines can be a real headache. But proper diagnosis and treatment can lessen the pain a bit

By Amy Hotz
Staff Writer
February 19, 2002

 

Ulysses S. Grant and Robert E. Lee fought on opposing sides during the Civil War, but they   shared a common enemy: migraines. 

Lewis Carroll tried to find a cure for his migraines, but with little success.

Later, he used the auras from his attacks to create the vivid psychedelic imagery that made Aliceís Adventures in Wonderland his most recognized work.

   
The National Institute of Neurological Disorders and Stroke estimates that 28 million Americans suffer from migraines. About 75 percent of Americans affected by migraines are women, according to the institute. That's about 21 million people. For most, the illness doesnít come with a silver lining. Debilitating symptoms

affect their careers, relationships and self-esteem.

"I have letters that will just bring you to tears. I handled three suicide calls just this week," said Michael John Coleman, medical advocate and founder of MAGNUM, the National Migraine Association. Mr. Coleman has suffered from migraines since age 6.

Recent findings, though, have raised new hopes for people who experience migraines. Because of recent discoveries into the cause of migraines, medical treatments have changed. Within the past five years, doctors have successfully used triptans and anticonvulsants initially developed for epileptic patients to ease the pain or prevent migraines, said Dr. Alfred DeMaria, a neurologist with Wilmington Health Associates.

"The old theory is that migraine is a so-called vascular headache - the blood vessels are involved," he said.

Now it is thought that blood vessels do contract and expand during the attacks, however, the real source of the pain, Dr. DeMaria said, may actually originate in the brainís nerve cells.

The problem could stem from genetics and affect descendants similar to the way diabetes affects descendants, he said. A person is more prone to get migraines if someone in their family did, though it is not always the case.

In the later part of 2000, Mr. Coleman said, doctors in Australia discovered the genetic code for migraines, which can involve as many as three genes.

The illness produces symptoms that can vary in intensity and come in many combinations. A migraine is not just a headache. Head pain is just one of the symptoms.

"I talk to people all the time who have migraines, but theyíve never had a headache," Mr. Coleman said.

The two main types of migraines are classic and common. Classic migraines usually occur with a hallucination, or aura, that warns of an impending headache.    Common migraines do not.  Some sources classify migraines into the same groups but with different names ñ migraine with aura and migraine without aura.

Migraines may include sudden changes in eyesight such as spots, double vision, temporary or partial blindness and zigzagging lines that look like multi-pointed stars, often described as English castles as seen from the air.

Migraine sufferers may feel numbness and tingling in the lips, face, hands, arm or leg, along with dizziness, drowsiness, confusion or slurred speech.

As the warning signs disappear, the person may get a throbbing headache on one side of his head that may shift to other areas of the head while increasing in pain, sometimes causing nausea or diarrhea. People experiencing these symptoms may also become sensitive to light and noise.

"Just a regular bad migraine can mimic stroke down to the nth degree," Mr. Coleman said.

Migraines also can cause strokes, serious heart problems, tooth loss and comas.

"It can be very disabling," Dr. DeMaria said.

Those who have migraines often don't look for treatment because the condition is difficult to diagnose, he said. The headaches can overlap with other types of headaches and there is no test to determine if someone has migraines. Dr. DeMaria said that every day he sees patients who have already been to a number of doctors, such as eye doctors and chiropractors, for treatments of migraine symptoms.

Mable Cooke was fortunate. She went to a doctor in the 1960s to get help for the severe headaches she'd experienced all her life.

"His wife had migraines and he knew exactly what they were," Ms. Cooke said.

At a young age, she began having migraines weekly, sometimes twice a week. They would begin with auras of red circles and blurred vision and then she would get the painful headaches.

"The whole right side of my head would just feel like it was going to explode," she said. "I was really frantic one because when the headache was gone, I could hardly see."

The pain was so severe that she would become nauseous and couldn't keep oral medications in her system. Her husband would have to drive her to a hospital where the doctor would meet them and give her a shot of the narcotic Demerol for the pain and another medication for the nausea. Many times, Ms. Cooke would also have to be given an IV because she was so dehydrated from the nausea.

The doctor prescribed a preventative medication, but it made her sick in other ways. Ms. Cooke said that she never found out why the attacks occurred, she kept a food diary, but it didnít seem to reveal any triggers.

She hasn't had a severe migraine attack in 10 years. About five years ago, a doctor prescribed Imitrex and the headaches began tapering off even more. Some people naturally grow out of migraine attacks completely, Dr. DeMaria said.

The illness caused a few changes in Ms. Cooke's life. She never knew when or where they would hit. One Christmas was interrupted with a trip to the hospital.

"Sunlight will make you crazy," she said.

 Triggers

Once a patient has been diagnosed with migraines, there are several things they can do to prevent an attack and to lessen the effects of an attack. Most importantly, Dr. DeMaria said, is identifying what triggers the migraines in specific individuals and taking those elements out of your life as much as possible.

"Never go anywhere without sunglasses," Mr. Coleman said.

Certain foods such as red wine, chemicals including perfumes, aspartame, monosodium glutamate, smoke and gasoline, lack of food or sleep, bright lights, hormones in women, relaxation after stress and emotional and physical fatigue, even sex, are a few of the common triggers.

Almost all alcoholic beverages can trigger a migraine, especially beer and red wine.

Some women experience migraines several days before their menstrual cycles, others regularly experience migraines on the first day of their cycle. A fall in the level of estrogen could be the cause of these attacks.

Women who have migraines should take special care not to combine birth control pills and cigarettes because it greatly increases the risk of stroke.

"Thatís like asking for it," Dr. DeMaria said.

Treatments

Over the counter remedies have proven successful in preventing migraines in some cases. Calcium, magnesium, vitamin B2 and an herb called feverfew, help treat migraines in some people. Others may try yoga, biofeedback or simply living a healthy lifestyle.

While exercise is a common migraine trigger, people with migraines may be able to ease into a moderate exercise routine without adverse effects.

"But ultimately, when those things fail we're left with medicines," Dr. DeMaria said. "There's a lot of trial and error with it."

Mr. Coleman listed four areas of migraine treatments with abortive treatments that included triptans such as Imitrex, Maxalt, Zomig and Axert. Two others are on the horizon, he said, frovatriptan and eletriptan. The second area, preventative treatments, consist of anticonvulsive drugs and Zestril and Botox.

"With preventatives - this is very, very important - one at a time," Mr. Coleman said.

The third area of treatment, general pain management, includes narcotics, anti-inflamatories and over the counter drugs as well as leading a healthy lifestyle, yoga and biofeedback. Last, Mr. Coleman suggests finding your personal migraine triggers and getting them out of your life.

"It might take years to find them all out," he said.

Amy Hotz: 343-2099 or

amy.hotz@wilmingtonstar.com

What is a migraine headache? 
A recurrent, throbbing headache generally felt on one side of the head also can switch from one side to another. Migraines usually begin in early childhood adolescence or young adult life.
The following items and events (precipitants) have been reported to cause migraine attacks: hunger, cheese, changes in weather, nuts, fatigue, avocados, oral contraceptives, menstrual periods, food cured with nitrates (e.g., hot dogs),  meat tenderizers (e.g., MSG) and alcoholic beverages.
Migraines can last from a few hours up to several days.
 
The two main types of
migraines:
Although there are several kinds of migraines, the most common are classic migraine - a migraine with aura - and common migraine, which has no aura.

Classic migraine If you're among the 10 percent of adults who have migraines with aura, you'll likely have warning signs about 20 minutes before the headache begins. These may include:
*  Sparkling flashes of light
*  Dazzling zigzag lines in your field of vision
* Slowly spreading blind spots in your vision, double vision
* Weakness, numbness or tingling in your face, lips, hand or leg 
*  Difficulty seeing or speaking
* Unsteadiness in walking, drowsiness, slight confusion of thinking
The symptoms may last for 5 to 15 minutes or more. As these symptoms disappear, a throbbing headache begins on one side of the head.
The severity of the headache builds. Once the headache becomes very painful, people often have nausea, vomiting and sensitivity to light and noise.

Common migraine
Although a migraine without aura has no classic warning signs, you may have one or more symptoms of premonition several hours before your headache actually strikes, including:

* Feelings of elation or intense energy
* Cravings for sweets
* Thirst
* Drowsiness
*  Irritability or depression
 
The location of the headache varies. The pain may be on both sides of the head, or it may shift from side to side. Nausea, vomiting and sensitivity to light and noise usually accompany the headache.
Children who have migraines experience mostly common migraines and, therefore, do not have any warning. In addition to the headache, some children experience abdominal pain, which gets better after vomiting.

Source: McKinley Health Clinic

 
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